The protrusion of three discs above the lumbar 4-5 disc is called high lumbar disc herniation, accounting for 1%-10% of lumbar disc herniations. Because the symptoms and signs are not as obvious as those of L4-5 and L5S1 herniations, misdiagnosis and underdiagnosis reach 30%-40%. Pathogenesis L3, 4 nerve roots from the dural division is lower than the same sequence number of discs, and immediately oblique outward out of the intervertebral foramen, in the spinal canal is not adjacent to the disc, which is different from L5, S1 nerve roots immediately adjacent to the disc, pain is only from the protrusion stimulation stretching the annulus fibrosus, posterior longitudinal ligament and the anterior wall of the dura, if the protrusion is large, is also across the dura to compress the cauda equina nerve root in it. Therefore, it presents as widespread, non-severe and atypical signs and symptoms. Clinical manifestations Upper lumbar pain, radiating pain half along the femoral nerve and upper lumbar nerve to the groin and anterior thigh, a few reach the medial calf, 1/3 along the sciatic nerve, hyperalgesia area mostly in the groin, anterior thigh to medial calf, hip extension or heel and hip test pulling the femoral nerve causes half of the pain, quadriceps muscle strength is reduced, leg lifting is weak and easy to fall, knee reflex is weakened. Regarding the straight leg raise test, because the L4 nerve root is involved in the composition of the femoral nerve and sciatic nerve respectively, when the straight leg raise is seen intraoperatively, the L4 also moves forward and is close to the prominence, so both the femoral nerve pull and the straight leg raise test can be positive. Imaging X-ray plain radiographs join the clinically visible upper lumbar space narrowing, the posterior longitudinal ligament may be calcified, the posterior edge of the vertebral body may be elevated and sclerotic, and the lumbar physiological anterior convexity may disappear and degenerate. Myelography has incomplete or complete obstruction at the level of the high lumbar disc, the corresponding dural sac is compressed, and the epidural space of the vertebral canal retains a small gap; CT sees the high lumbar disc protruding backward and calcification, which can account for half of the vertebral canal area in heavy cases; CTM results are the same as above, and MRI is better. Diagnostic points 1, upper back pain, even if there is no nerve root compression symptoms, do not exclude LDP above L3, 4. 2, with L3, 4, S1 multiple nerve root compression symptoms, in addition to the lesser double protrusion, triple protrusion, should be more considered as a high LIDP of near-central type. 3, thigh posterior extension test positive at the same time, if also straight leg elevation test positive, mostly LDP above L3, 4. 4, thigh anterior pain and hyperalgesia, quadriceps muscle strength and knee reflexes, although the positive rate is not high should also be considered high LIDP. 5, CT or myelography is more significant. Treatment non-surgical treatment is generally effective, but because the local in the upper lumbar segment and lower thoracic segment is the stress line distribution changes, improper activities and functional exercises after treatment can cause re-irritation and compression, often easy to repeat.